NPIMap

Organization Active NPI

Anesthesia Specialists of Warren, LLC

  • Anesthesiology Physician
  • Phillipsburg, NJ
National Provider Identifier
1104354422
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ANESTHESIA SPECIALISTS OF WARREN, LLC
Practice address
185 Roseberry St
Phillipsburg, NJ 08865-1690
Phone
(610) 954-5810
NPI assigned
May 31, 2017
Last updated
Aug 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Dequevedo, MDNPI 1336107788
Title
Authorized Official
Phone
(610) 954-5810

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

185 Roseberry St
Phillipsburg, NJ 08865-1690

Mailing address

PO Box 327
Souderton, PA 18964-0327

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170809001980 NJ Part B Supplier - Clinic/Group Practice 5294006250 Receives reassigned benefits from 68 practitioners
Practice locations: Phillipsburg, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 165

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 165

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1104354422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 327",
            "city": "SOUDERTON",
            "state": "PA",
            "postal_code": "189640327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 ROSEBERRY ST",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088651690",
            "telephone_number": "610-954-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIA SPECIALISTS OF WARREN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "DEQUEVEDO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "610-954-5810",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phillipsburg, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.